1386785004 NPI number — VIRGINIA PEDIATRIC GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386785004 NPI number — VIRGINIA PEDIATRIC GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA PEDIATRIC GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386785004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10041 OAKTON TERRACE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22124-2938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-242-8627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3020 HAMAKER CT
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-280-9597
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAUGH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PATRNER AT VIRGINIA PEDIATRIC GROUP
Authorized Official Telephone Number:
703-280-9597

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  0110001944 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)